HomeMy WebLinkAbout026-1296-06-000 I
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
499239 0
ATTACH TO PERMIT)
GENERAL INFORMATION ( State Plan ID No:
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name: City Village X Township Parcel Tax No:
Country View Ridge LLC I Richmond, Town of 026- 1296 -06 -000
CST BM Elev: Insp. BM Elev: BM Description: SectionlTown /Range /Map No:
60 r V � G� — 07.30.18.1537
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER VC Al CAPACITY STATION BS HI FS ELEV.
i
/a3•
Septic 2- Benchmark
d F'► /��d �J • � fps ���
Desicig Alt. BM ° Z • ( /0 /, Z
6em�'
Aeration Bldg. Sewer e ��
Holding St/Ht Inlet
TANK SETBACK INFORMATION SUHt Outlet
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic / J /I 7Z i „ Dt Bottom �—
Dosing Header /Man.
Aeration Dist. Pipe o 7• �j 5
4.15 `t$• /5
G am
Holding Bot. System g, o 9 � yyr Z rrL
Final Grade
PUMP /SIPHON INFORMATION � may'
Manufacturer Demand St Cover I
_ GPM ��� �c� Co $ /6 /•Z 2 . /6!• Z
Model 71,16—r
TDH ift Friction Loss System Head TDH Ft
Forcemain th Dia. ist. to Well
SOIL ABSORPTION SYSTEM
BED /TRENCH Width / Length No. Of Tre nches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 2 (_ Z 6 � - ,, w � -- � �— \
SETBACK SYSTE TO f+ P/L BLDG WE LAKE /STREAM LEACHING Manufacturer:
INFORMATION �) 3
Type Of System: / CHAMBER OR f't
YP Y /� / UNIT Model Nu r:,
Ga AV A/ 1'6 33 /Jl"T /V � u c�.
DISTRIBUTION SYSTEM
Header /Manifold Distribution x Hole Size _ T ole Spacing Vent to Air take
Pipes) \ Z w /
Length Dia Length Dia Spacing / f
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over / Depth Over xx Depth of xx Seeded/Sodded xx Mulched
Bed/Trench Center Bed /Trench Edges l Topsoil \ Yes No Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / ` \ Inspection #2:
Location: 980 165th Avenue Unknown (NE 1/4 SE 1/4 7 T30N R1 8W) Country View Ridge Lot 6 / Parcel No: 07.30.18.1537
1.) Alt BM Description
2.) Bldg sewer length = '7 2
- amount of cover
�o
Plan revision Required? Yes ')< No
Use other side for additional information. _
Date Insep or's Si ature Cert. No.
SBD -6710 (R.3/97)
' Safety and Buildings Division County
201 W. Washington Ave., P.O. Box 7162 r O ti
8 V&cons i n Madison, W1 53707 - 7162 Sanitary Permit Number (to be filled in by Co.)
(608) 266 -3151 9 ?,-, "39
Department of Commerce srau clan 1`Numt�er� -1
Sanitary Permit Application N'
In accord with Comm 83. secondary purposes Code, personal inf , sl u provide ' 3 b t � � g )
maybe used for seconndary purposes Privacy Law, s1 3.t)4(1
T. Application Information — Please Print All Information
q gf
Property Owner's Name Pared # Lot # Block #
operty Location (/Q
Property Owner's M ' g Address
V., � %, section
City, State ,� / i Zip Code Pho b
, 1 (� N; p cl one)
R W
IL ype of Building (check all that apply) S S bivision Name CSM Num
2 Family Dwelling - Number of Bedroo n L`
❑ public/Commercial - Describe Use ❑City_ ❑Villa wnship of 4
❑ State Owned - Describe Use
1II Type of Permit: (Check only one box on line A. Complete line B if applicable) O 2(p - Zq - 06 S
A. System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ other Modification to Existing System
❑Change of ❑Permit Transfer to New
List previous Permit Number and Date Issued
B. ❑ Permit Renewal El Permit Revision
I
Before Expiration Plumb Owner / ^�
tp � ' t
IV. of POWTS System: Check all that a
- pressurized In- Ground ❑ Mound ? 24 m• of suits a soil C1 Mound < 24 in. of suitable soil 11 At-Grade Single Pass Sand Filter ❑
Consumted Wetland ❑ Pressurized In- ound El Holding Tank ❑Peat Filter ❑Aerobic Treatment Unit ❑ Recirc j Sand Filter ❑
Recirculating Synthetic Media F' Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain)
V. Dis ersal Treatmeat A formation: Dis rsal Area Proposed (sf) System Elevation
Design Flow (gpd) Desi oil Application Rate(gpdsf) Dispersal Area Required (sf) pe�
J - � 6
VI Tank Info ' Capacity in Total Number Manufactured yL Prefab Site Fiber Plastic
Gallons Gallons of Units w ( CT-" Concrete Constructed Glass
New Existing 1
Tanks Tanks
Septic or Holding Teak �'
Aerobic Treatment Unit
Dosing Chamber
VII. Responsibility Statement - 1, the unders' , assume responsili ity for installation of the POWTS shown on the attached plans
Plum ignature MP/Mr" Number Business Phone Number
Plum is Name (Print)
\
Plumber's Address (Street City, �� i�)
;ed . Coun /De artment Use Onl
Sanitary Permit Fe eludes Groundwater Date Issued Issuing Ag Signature (No p )
pprov ❑ Disa rven Reas Surcharge Fee) i /� ❑
on o ial
DL Conditio A o
SYST R:
1 Septic tank, effluent filter and
dispersal cell must all be sgrviced / maintained
as per management plan provided by plumber.
2. All setback requirements must be maintained
as per applicable code /ordinances.
Attach complete plans (to the County only) for the system on paper not less than Sla x l I inches in size
SBD -6398 (R. 01/03)
LOT LAN
PROJECT Country View Ridae LLC DRESS P.O.Box 176 New Richmond Wi 54017
NE 1/4 SE 1 /4S 7 /T /R 18 W TOWN Richmond COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 10/31/06 BEDROOM 3
CONVENTIONAL )00( IN -G ND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 650 # of chambers 26
hk BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100 Filter BEST Filter
❑ BOREHOLE O WELL * H. R. P. Same as Benchmark �~
Well is to meet all
setbacks required by SYSTEM ELEVATION 97.9/97.2 4.5' below qrad
i WDNR
B.M. 169' Property Line Plans Designed Using
Vent Conventional Powts
Manual Version 2.0
>6 „ ARC 36 Biodiffuser
of Cover Leaching Chamber
with 25.0 ft2 of Area
5' Long 1 1 "
36' Grade at System Elevation
Vents
30' B -2
35' 175'
2 -3' X 69' Cells with >3' Spacing a
75
Scale is 1" = 40' -�
unless otherwise 35'
noted a
30'
30' B
ST
3'
372' Property Line
Pro 3 Bedroom
House
n,
LOT LAN
PROJECT Country View Ridae LLC DRESS P.O.Box 176 New Richmond Wi 54017
NE 1/4 SE 1 /4s 7 /T /R 18 W TOWN Richmond COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 10/31/06 BEDROOM 3
CONVENTIONAL XXX IN -G ND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 650 # of chambers 26
BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100' Filter BEST Filter
❑ BOREHOLE O WELL *H. R. P Same as Benchmark
Well is to meet all
setbacks required by SYSTEM ELEVATION 97.9/97.2 4.5' below qrade
* WDNR
B.M. 169' Property Line Plans Designed Using
Vent Conventional Powts
Manual Version 2.0
>6 » ARC 36 Biodiffuser
of Cover Leaching Chamber
with 25.0 ft2 of Area
5' Long 11 "
3 6" Grade at System Elevation
Vents
30' B -2
35' 175'
2 -3' X 69' Cells with >3' Spacing
75'
Scale is 1" = 40'
unless otherwise 35'
noted
30'
3 0' �-
ST
3 0'
372' Property Line
Pro 3 Bedroom
House
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County Jf Cr l X
include, but not limited to: vertical and horizontal reference Parcel I.D.
percent slope, scale or dimensions, north arrow, and ocatio rl�I est r d.
Please print all infor ation. � 4 r �, �� p Reviewed by Date
Personal information you provide may be used for seconds purpos a l 8W. a rt876A (1) (m (p
Property Owner Property Lo tion
( F�O6 Mot � 36) 1/4 1 /4 S T , N R f E (o W
Propert Mailing Add # Subd. Name or CSM#
7� a J L JZ 7 �o .t'- — 6 Iu
City State 7Pp Code Phole Number ❑ C. ❑ if age To4W Nearest Roa
New Construction Use:5KSesidential / Number of bedrooms J Code derived design flow rate J Z� GPD
❑ Replacement ❑ Public or mmeraal - D scribe:
Parent material i � Flood Plain eleva tion if applicable /?/ - 1 ft.
General comments 7 (j
and recommendations:
/ S
Boring # Q Boring
Pit Ground surface elev. [ D�l ft. Depth to limiting factor � Lc� in.
Soil Appl ication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft?
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2
lz Xa 14,
t
Bori ® # Boling
Ground surface elev. �/ Depth to limiting factor _ in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Ou. Sz. Cont Color Gr. Sz. Sh. `Eff#1 `Eff#2
0—/2- 3 /c_ S o� �r C S 8+'Y7 0
11 3 D ! D o e s/ �/ �-� C I m 5,6 k rYt Cr- �,•� I t= <
d/ o f S Os I
t
Effluent #1 = BOD > 30 220 mg/L and TSS >30 150 ` Effluent #2 = BOD _< 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Address Date Evaluation Conducted Telephone Number
1008 192nd Ave, New Richmond, WI 54 17 J !"'� — 715 - 246 -4516
Property Owner _ Parcel ID # Page of
Boring # F1 Boring
S] -_ - - A Pit Ground surface eiev. l m�- Depth to limiting f! in. Soil Application Rate
f
Horizon Depth Dominant Color Redox Description Texture gstructure Boundary Roots GPDIfF in. Munsell Qu. Sz. Cont. Color 'Eff#1 'Eff#2 3
s r t �i c
C
a
Boris # ❑ Borin
Pit Ground surface elev. ft. Depth to limiting factor in• Soil lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 ' ff#2
S C
( `
❑
Boring # Boring Ground surface elev. ft. Depth to limiting factor in.
❑ Pit Soil Application Rate
Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/fP
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eft#1 'Eff#2
Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mgIL ` Effluent #2 = BOD, 1 30 mglL and TSS < 30 mg1L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777.
580.8330 (8.6/00)
f -
Soil Test Plot Plan
Project Name Country View Ridge LLC Shau ird
Address P.O. Box 176
New Richmond Wi 54017
CSio #226900
Lot 4 Subdivision Country View Ridge Date 5/20/05
N E 1/4 SE 1/4S 7 T 30 N /R W Township Richmond
[] Boring Q Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Top of Survey Iron /Nail
System Elevation 97.9/97.2 *HRPSameasBenchmark
4 B.M. 169' Property Line
30' B -2
35' 175'
75 N
Scale is 1" = 40' B -1 A �
unless otherwise 35'
noted
30'
B-
102'
100'
372' Property Line
Maintenance and Contingency Plan for a Septic System
Maintenance Plan
1. Septic Tank is to be pumped once every 3 years.
2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in
order to extend the maintenance interval of the filter.
3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of
the cells.
4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system.
5. The owner agrees to save this plan.
6. Do not plant trees nor park nor drive over system.
7. Watershed is to be diverted away from system.
8. Discharge into system is not exceed those required as per Comm. 83
C Plan
Option #1 system fails, determine cause of failure, use alternate area and install new
system in tested replacement area.
Option #2. Install system at a lower elevation, by removing chambers, removing biomat,
and install new system.
Option#3. No adequate area is suitable for replacement area, and system elevation
cannont be lowered. Install holding tank as last resort.
3. Replace any other failing components as needed.
Plumber: Shaun Bird 715 -246 -4516
St. Croix County Zoning 715- 386 -4680
Pumper Tom Mondor 715 - 246 -5148
Shaun Bird #226900
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWI, CERTIFICATION FORM
owner/Buyer Ci/��l✓� 6
14
Mailing Address '
Property Address (/ Dartment for new construction_)
('Verification required from Planning & Zoning ep
City/State Parcel Identification Number D _
(� l
LEGAL DESCRIPTION ,
J i Sec. , T 3 o N R, Town of
Property Location i/a , � _ ,
r Lot #
Subdivision ���{ f�J �.�✓ _
Volume '// , Page #
Certified Survey Map # �-C i , Page
Warranty Deed # % %y " , Volume
ye
Lot lines identifiable no
Spec hour no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
failure to handle i o What you put into
Improper use and maintenance te septic tank every three years or so oner,
needed by a licensed pum�per�• Proper
P of Your Septic system could
maintenance consists of p P
the system can affect the function of the septic w and n treatment St Croix County Sanitary Ordinance-
are specified in §Comm. 8352(1) P
s to submit to St. Croix County Planning & Zoning Department a certification form, signed by the
The property owner agree that (1) the on -site
owner and by a master plumber, journeyman plumber, restricted Plumber or a licensed pumper verifying tic tank is
wastewater disposal system is in proper operating condition and/or {2) after inspection and Pumping (if necessary), the septic
less than 1/3 full of sludge. _ with ft
I/we, the undersigned have read th a bove; of Co and the Department of Natural Resources, State of Wiscons
standards set forth, herein, as set by the p
be completed and returned to th
Certification stating that your septic system has been maintained must e St Croix County Planning
Zoning Department within 30 days of the three year expiration date.
Uwe certify that all statements on this form are true to Re t' o f
of Deeds kno wledge- Uwe am/are the owner($) of the
prop described above, by virtue of a warranty deed record / , /
DATE
SIGNATURE APPLICANT(S)
i that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning DepamnenL * *
Any mf
eed from the Register of Deeds office and a copy of the certified survey map if
Include with this application a recorded warranty d
reference is made in the warranty deed.
(REV. 08105)
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U 2656P 061 774312
STATE BAR OF WISCONSIN FORM 1 - 1999 KATHLEEN H. WALSH
WARRANTY DEED REGISTER OF DEEDS
Document Number ST. CROIX CO., WI
This Deed made between Gerald A. Kieckhoefer, Jr. and David RECEIVED FOR RECORD
J. Kieckhoefer Grantor, and Country View 09/14/2004 10:26AK
Ridge, LLC Grantee. WARRANTY DEED
Grantor, for a valuable consideration, conveys and warrants to Grantee EXW #
the following described real estate in St. Croix County, State of Wisconsin
(the "Property ") (if more space is needed, please attach addendum): REC FEE: 13.00
TRANS FEE: 1410.60
See attached Exhibit A COPY FEE:
CC FEE:
PAGES: 2
Recording Area
Name and Return Address
^N
26- 102540 -000
Together with all appurtenant rights, title and interests. 026 - 102430 -000; 026 - 102440 -000; 026- 1025 -30-0
Parcel Identification Number (PIN)
This is not homestead property
(is)
Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except
easements, res and reservations, if any, of record.
Dated this y r4— day of 2004
* Gerald A. Kieckhoefer, Jr. * David J. Ki khoefer
* *
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) Gerald A. Kieckhoefer, Jr. an_ d David J. STATE OF )
Kieckhoefer ) ss.
'�,[ County )
authenticated this w` da of 2004
Personally came before me this day of
the above named
* Kristina Ogland
TITLE: MEMBER STATE BAR OF WISCONSIN
(if not, to me known to be the person(s) who executed the foregoing
• authorized by § 706.06, Wis. Stats.) instrument and acknowledged the same.
THIS INSTRUMENT WAS DRAFTED BY
Kristina Poland, Estreen & Ogland
304 Locust Street, Hudson, WI 54016 Notary Public, State of
My Commission is permanent. (If not, state expiration date:
(Signatures may be authenticated or acknowledged. Both are not necessary.) )
* Names of persons signing in any capacity must be typed or printed below their signature. Information Professionals Co., Fond du Lac, WI
STATE BAR OF WISCONSIN 800-655 -2021
WARRANTY DEED FORM No. 1 - 1999
U 2656 P 062
Exhibit A
Located in ,
part of the SE / of the NE /., the NE '
SW + / f the SE the NW
/. of the NE / of S , / of the 5E' /, and
t� , Towns the
St T ownship 30 North�Ran a 18
Of S VI% est' Town of
Croix, State of Wisconsin described as follbws:l 9 . Richmond, County
Commencing at the East quarter comer of said Secti n 7, this also being the Point of Beginning;
Thence S00 °37'10 "E along the East line of the SE �/ of said Section 7 a distance of 13agi feet
Thence S89 on the northerly line of a Ce ad Survey Map recorded In Volume 13 P
3752 a distance of 610.00 feet; Thence 3 00 ° 37'10")= 4
00 ° 37'10")= on the Westerly line of said Certifted survey age
Map 428.42 feet (Record 428.50 feet); Thence S89 °J18'52"W along the south line of N %Z of the
SE '/ of said Section 7 a distance of 1146,36 feet Thence N00 °33'S3"VI/ 1384,45 feet; Thence
N88 0 57'22 "E 1048.00 feet; Thence N51 0 00'00 °E 25 .00 feet; Thence N88 507.00 feet to
a point on the East line of the NE % of said Section ; Thence S00 °40'35 °E along $aid East�line of
the NE % of said Section 7 a distance of 248. 0 feet to fhe Point of 6e1jinning and there
terminating.
i
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- v l• JL
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Located In part of the Southwest Quarter of
the Northeast Quarter of the Southeast
Township 30 North, 9 e
is plat with respect to
and 236.21(1) and (2),
236.12, Wis. 5tats.
$ 20 oS
UNPLA T IED LANDS
nistration
Bench Mark
Top of 2" o. D. Iron Pipe
Elevation 977.14 ft - NI VD 88
1048.00' 196.08'
N88'57' 22"E 1 68.59'
220.00'
5
220.00'
• — orth Line of the 81,611 s
Northeast Quarter of 1.874 a<
m 6 the Southeast Quarter �= LB0 = 9
0 rn M
I M
M
7 6
3 8 792 s
e�
8 a,
3
87,918 sq.ft. M 1. 1 es N
= 87,918 sq.ft. M 2.018 acres
�+) 2.018 acres O p N
!V O
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K �- /
eynt - - 22.95 -�� ,
P
writing by
fond upon -0 / 3
O _ _ _ 20.00' — — 112.44'
- - - -
— — — - - - - 220.00'— .................. 4
799.12 1 65TH __— 6 6
N88'57'2 "E — —
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' M _ - 259.18 - — 47.80 —
__ -- N88'57 22 E
» 69 _ — — — N26'12'26 "W`
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lot M I 16 17
,eel , ;hI Ito I M 1 00 i W.12 •q• ft•
� .. !`�. (� 2.WO acres _ 87_130 sq.ft.